title: Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric, adolescent and young adult varicoceles.
abstract: OBJECTIVE
  Anatomical variations on venous drainage in varicoceles are under-reported. We report our experience in scrotal antegrade sclerotherapy (SAS) for adolescent varicoceles.
  
  
  METHODS
  Since 2011, 15 consecutive boys with left varicoceles were recruited. Under general anaesthesia, a 5-mm transverse incision was made at scrotal neck, testicular vein was cannulated at pampiniform plexus with venogram performed. Foam sclerosant by mixing sodium tetradecyl sulphate (STS), Lipiodol(®) and air was slowly injected under fluoroscopy. Postoperatively the patients were followed-up for varicocele grading, testicular size, and complications.
  
  
  RESULTS
  Median age at operation was 14 (10-19) years. 80 % had grade three varicoceles, 33.3 % had smaller left testis before operation. Intra-operative venogram showed three different anatomical variations. Group I: eleven patients (73.3 %) had single distinct internal spermatic vein; Group II: two patients demonstrated duplication of internal spermatic vein draining into left renal vein; Group III: two patients had pampiniform plexus draining to iliac and/or paraspinal veins. SAS was performed in Group I and II patients. Sclerosant volume injected ranged from 1.5 to 4.5 ml. In Group III patients, surgical ligation of testicular veins was performed rather than SAS to avoid uncontrolled systemic sclerosant spillage. Mean length of stay was 1.13 day. One patient with scrotal haematoma and one other with minor wound dehiscence were managed conservatively. Mean follow-up period was 10.9 (1-22) months. Thirteen patients (86.7 %) achieved varicocele grading ≤ 1. There was no postoperative testicular atrophy, hydrocele and epididymo-orchitis.
  
  
  CONCLUSIONS
  Scrotal antegrade sclerotherapy using STS foam is a safe and effective treatment for adolescent varicoceles. Anatomical variations on venous drainage in varicoceles are common.
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, 30, Gascoigne Road, Kowloon, Hong Kong.
authors.forename: Y S
authors.initials: YS
authors.lastname: Wong
authors.forename: K L Y
authors.initials: KL
authors.lastname: Chung
authors.forename: K W Y
authors.initials: KW
authors.lastname: Lo
authors.forename: C S W
authors.initials: CS
authors.lastname: Liu
authors.forename: T W
authors.initials: TW
authors.lastname: Fan
authors.forename: S K S
authors.initials: SK
authors.lastname: Tse
authors.forename: P M Y
authors.initials: PM
authors.lastname: Tang
authors.forename: N S Y
authors.initials: NS
authors.lastname: Chao
authors.forename: K K W
authors.initials: KK
authors.lastname: Liu
authors.forename: M W Y
authors.initials: MW
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D012611:Scrotum / Q000033:anatomy & histology / Q000098:blood supply*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use; D013737:Testis / Q000033:anatomy & histology / Q000098:blood supply; D016896:Treatment Outcome; D014646:Varicocele / Q000628:therapy*; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate